Question 1

The primary care nurse practitioner (NP)sees a patient in the clinic who has a blood pressure of 130/85 mm Hg.The patient's laboratory tests reveal high-density lipoprotein,35 mg/dL; triglycerides,120 mg/dL; and fasting plasma glucose,100 mg/dL.The NP calculates a body mass index of 29.The patient has a positive family history for cardiovascular disease.The NP should:

A) prescribe a thiazide diuretic.
B) consider treatment with an angiotensin-converting enzyme inhibitor.
C) reassure the patient that these findings are normal.
D) counsel the patient about dietary and lifestyle changes.

Accepted Answer

The patient's blood pressure indicates prehypertension,but the patient does not have cardiovascular risk factors such as hyperlipidemia or hyperinsulinemia.The body mass index indicates that the patient is overweight but not obese.Pharmacologic treatment is not recommended for prehypertension unless compelling reasons are present.The findings are not normal,so it is appropriate to counsel the patient about diet and exercise.

Question 2

A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions.The patient does not smoke,has a body mass index of 24,and exercises regularly.The patient has no known risk factors for cardiovascular disease.The primary care NP should:

A) prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
B) perform a careful cardiovascular physical assessment.
C) counsel the patient about dietary and lifestyle changes.
D) order a urinalysis and creatinine clearance and begin therapy with a b-blocker.

Accepted Answer

If the patient is younger than 20 or older than 50 years old at the onset of elevated blood pressure,the NP should look for causes of secondary hypertension.The physical examination should include a careful cardiovascular assessment.This patient will need pharmacologic treatment,but not until the underlying cause of hypertension is determined.

Question 3

An 80-year-old male patient will begin taking an a-antiadrenergic medication.The primary care NP should teach this patient to:&#10;A) ask for assistance while bathing.&#10;B) restrict fluids to aid with diuresis.&#10;C) take the medication in the morning with food.&#10;D) be aware that priapism is a common side effect.

Accepted Answer

All antihypertensives can cause orthostatic hypotension,so patients should be cautioned to avoid sudden changes in position and to use caution when bathing because a hot bath or shower may aggravate dizziness.Older patients are at increased risk for falls and should be cautioned to ask for assistance.Patients taking a-antiadrenergics should consume extra fluids because dehydration can increase the risk of orthostatic hypotension.Patients should take the medication at bedtime because drowsiness is a common side effect.Priapism is not a side effect of these drugs.

Question 4

The primary care NP sees a new African-American patient who has blood pressure readings of 140/90 mm Hg,130/85 mm Hg,and 142/80 mm Hg on three separate occasions.The NP learns that the patient has a family history of hypertension.The NP should:

A) initiate monotherapy with a thiazide diuretic.
B) prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
C) discuss dietary and lifestyle modifications with the patient.
D) begin combination therapy with an ARB and a calcium-channel blocker.

Accepted Answer

African Americans tend to respond better than whites to diuretic monotherapy,so this is an appropriate starting therapy.Calcium-channel blockers and ARBs are preferred as adjunct medications in African Americans.

Question 5

A patient who has had a previous myocardial infarction has a blood pressure of 135/82 mm Hg.The patient's body mass index is 28,and the patient has a fasting plasma glucose of 105 mg/dL.The primary care NP should prescribe:

A) an angiotensin-converting enzyme inhibitor.
B) a thiazide diuretic.
C) lifestyle modifications.
D) a calcium-channel blocker.

Accepted Answer

This patient has prehypertension but has a compelling reason for treatment.Patients who have had a myocardial infarction should be treated with a b-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ARB).

Question 6

A patient has three consecutive blood pressure readings of 140/95 mm Hg.The patient's body mass index is 24.A fasting plasma glucose is 100 mg/dL.Creatinine clearance and cholesterol tests are normal.The primary care NP should order:

A) a b-blocker.
B) an angiotensin-converting enzyme inhibitor.
C) a thiazide diuretic.
D) dietary and lifestyle changes.

Accepted Answer

The patient has stage I hypertension.Because there are no compelling indications for other treatment,a thiazide diuretic should be used initially to treat the hypertension.Dietary and lifestyle changes should also be recommended but are not sufficient for patients with stage I hypertension.Other drugs may be added later if thiazide diuretic therapy fails.

Question 7

The primary care NP sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months.The patient's blood pressure at the beginning of treatment was 150/95 mm Hg.The blood pressure today is 138/85 mm Hg.The NP should:

A) order a b-blocker.
B) add an angiotensin-converting enzyme inhibitor.
C) continue the current drug regimen.
D) change to an aldosterone antagonist medication.

Accepted Answer

Evidence-based guidelines suggest that optimal control of hypertension to less than 130/80 mm Hg could prevent 37% of cardiovascular disease in men and 56% in women,so this patient,although showing improvement,could benefit from the addition of another medication.An angiotensin-converting enzyme inhibitor is an appropriate drug for patients who also have diabetes.b-Blockers and aldosterone antagonist medications are not recommended for patients with diabetes.

Deck 17: Hypertension and Miscellaneous Antihypertensive Medications